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Posts in "Medicaid"

March 9, 2015

Utah House Adopts Alternative Medicaid Plan

Utah lawmakers approved a more modest alternative to Republican Gov. Gary Herbert’s Medicaid expansion plan on Friday after a contentious debate.

The House’s 56-18 vote sends the measure to the state Senate. Herbert’s measure, known as Healthy Utah, passed the state Senate late last month but failed on Wednesday night to make it out of a House committee. The panel instead approved the alternative, called Utah Cares, which costs almost as much as Herbert’s plan but covers a much smaller population. The House bill would bring in a much smaller pot of federal matching grant money the governor’s plan.

House Majority Whip Francis Gibson, R-Mapleton, told representatives before the vote they should “feel free” to oppose Utah Cares, but called it “analogous to the guy in the desert who walks past a glass of water because he wants a gallon,” according to the Deseret News of Salt Lake.

Democrats tried to substitute Herbert’s proposal for the Utah Cares bill, sponsored by House Majority Leader Jim Dunnigan, the chamber’s second-ranked Republican, but fell short in a 22-52 vote, even as 10 Republicans joined the dozen members of the minority party.

Rep. Marie Poulson, D-Cottonwood Heights, a member of the Legislature’s Health Reform Task force that studied options for the Medicaid expansion available under the Affordable Care Act, said she was offended by the name of the House plan, according to the Deseret News account of the debate:

“We can care more. Utah needs us to care more about the lives of our citizens than we do about making a political statement,” Poulson said, calling the limited coverage offered by Utah Cares a “huge missed opportunity.”

Herbert had said he was open to suggestions floated by some lawmakers to approve both Healthy Utah and the rival plan, with one taking effect for a couple of years and the other being implemented later if the original plan doesn’t work well. But Herbert insisted that Healthy Utah should be implemented initially and that the narrower plan be available as a fallback option of costs turn out to be too high.

Herbert said that his program could be capped so that if costs exceed expectations, new applicants would not get the same benefits as people who were already enrolled and would be grandfathered into that level of coverage. Herbert won assurances from Health and Human Services Secretary Sylvia Mathews Burwell that the unusual cap would be approved.

The governor also sought to portray the House version as the fiscally unsustainable option. Because that bill would not expand Medicaid under the health care law, it would attract fewer federal dollars.

Matching Rate

The health care law provides a generous matching rate to states that expand to the population that Obama administration officials want. The administration will cover all of the costs through 2016 for people who qualify under expanded eligibility guidelines if states broaden the population to anyone with income up to 138 percent of the federal poverty level. That full financing phases down until the federal Department of Health and Human Services will cover 90 percent of the costs for those people starting in 2020.

The Utah Cares plan would not meet the federal requirements for the 100 percent federal matching money and cost $56 million in state revenues and draw down $139 million in federal matching grants in 2021, according to House legislative estimates. The program would cover an additional 32,000 adults with comprehensive care and provide basic care to 61,000 adults. The estimates include people who qualify under previous eligibility guidelines but learn of benefits and enroll for the first time.

The governor’s version would have cost $78 million in state funds while attracting $648 million in federal matching moneyin 2021. It would cover about 146,000 people.

Under Utah legislative rules, it would be rare for Dunnigan’s bill and Herbert’s plan to be reconciled in a conference committee.

“You can never say never, however,” said Gates, the spokesman for House Republicans. “And Rep. Dunnigan is never one to close a door.”

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By Rebecca Adams Posted at 9:23 a.m.

February 12, 2015

Another Health Care Program Added to Federal High Risk List

The complexities and cumbersome operations of federal programs were highlighted on Wednesday, as the Government Accountability Office updated its ongoing list of high-risk programs. The special tally identifies the most troublesome government programs due to vulnerabilities that can lead to waste, fraud, abuse, or mismanagement. The programs are deemed a high risk not only for the vulnerabilities but also an apparent lack of an effective policy for improvement. This year, after a year-long scandal over veterans’ treatment wait times, the Veterans Administration’s medical system has been added to high-risk list. The GAO notes that while Congress has passed legislation that addresses VA system problems and adds funding, the audit agency still needs to monitor how the VA implements the changes.

Adding the VA health system to the list adds another vulnerable health care concern to the 31 other worrisome programs. The Medicare program is a charter member and has been on the high risk list since the GAO began monitoring risky programs in 1990 – and it has not been removed from the list. Other programs currently programs on the tally are the Medicaid program, federal food safety monitoring and FDA oversight of medical products.

By Paul Jenks Posted at 9:31 a.m.
Medicaid, Medicare

February 11, 2015

Auditing Health Programs is a Full-Time Job

Four different congressional panels today focus on Government Accountability Office (GAO) efforts to monitor program implementation within the Department of Health and Human Services. The GAO is the main outside agency that examines HHS operations and its audit reports are frequently critical of the agency.

Two House Energy and Commerce subcommittees today cast a spotlight on recent audit reports. An oversight panel reviews a report on HHS leadership on mental health programs (view GAO report released on Feb. 5) which pegged HHS inter-agency coordination of programs supporting individuals with serious mental illness as “lacking.” The health subcommittee examines a report on HHS implementation of new health care disease codes (ICD-10, view GAO report released on Feb. 6). Additionally, a Senate panel this morning and a House subcommittee this afternoon mull the GAO’s efforts to monitor high-risk programs. The Medicare and Medicaid programs are charter topics for the auditor’s annual compilation of federal programs that are prone to fraud and waste risks.

The GAO on Tuesday provided lawmakers with additional fodder for more committee hearings, with two new audits calling for better planning and coordination of programs that address prenatal prescription drug abuse and action to improve the collection of money from third-parties covering health expenses of Medicaid recipients.

January 23, 2015

States Focus On Health Care

State governments and lawmakers have long focused on health care policy-making. The state portion of funding for the state-run but federally supervised Medicaid program takes up a large portion of the budgets of all 50-states. CQ Roll Call this week unveiled a new source for information on policy developments forged in the states: the CQ State Report. One can almost guarantee that health care policy topics will be included any weekly assortment of stories from the states. Here is a sample from this week:

California: Bill Would Expand Undocumented Immigrant Care

California: State Will Cover Medicaid Patients Stuck in Limbo

Arkansas: Hutchinson Seeks Task Force for Medicaid Changes

Missouri: Nixon Focuses On Education, Medicaid Expansion

By Paul Jenks Posted at 10:34 a.m.

January 22, 2015

Medicaid Programs Face Congressional Renewal Pressure

Several Medicaid and Children’s Health Insurance Program (CHIP) payment elements are subject to congressional action – or inaction this year. Funding for CHIP, which provides health coverage to more than 10 million children and teens, is set to expire in September 2015. If Congress does not provide a fresh injection of cash, 2 million people enrolled in the program may not be eligible to receive coverage from Medicaid, the federal-state health program for the poor, or through health care law insurance exchanges.

The Affordable Care Act allowed the program to continue through 2019 but only authorized funding for it through Sept. 30, 2015. Democrats last year eyed possible action on a renewal bill before the end of the last year. However, Republicans, seeking possible changes to the program, were reluctant to push for a renewal so far ahead the September 31, 2015 expiration. Separately, a temporary Medicaid primary care physician payment increase promoted by the 2010 health law and designed to match physician payments with Medicare rates expired on Dec. 31. Physician groups are seeking congressional action to extend the higher rates and a retro-active adjustment for current payments.

By Paul Jenks Posted at 7:55 a.m.
Children, Medicaid

December 22, 2014

Ahead for the New Congress: Physician Payment Adjustments

Congress will return in January with some new faces and a newly-minted Republican Senate majority (check out Roll Call’s guide to the 114th Congress) but lawmakers will face decisions on a an old topic. The first major item on the  health care legislative agenda is action on adjusting Medicare and Medicaid payments to physicians, which expire on Dec. 31 for special Medicaid reimbursement and March 31 for Medicare payments.

The primary roadblock for any physician payment adjustment is finding sufficient offsetting spending reductions in other programs (or tax increases) to pay for halting the payment cuts. The search for fiscal offsets has bedeviled action on physician payment measures for years and is shadowed by more troublesome decisions on federal deficit spending reduction. Health care and entitlement program spending, which accounts for the bulk of all federal spending, lies at the center of any effort to reduce annual spending deficits.

Note: Healthopolis will resume regular publication on Jan. 5. 


By Paul Jenks Posted at 8:57 a.m.
Medicaid, Medicare

December 12, 2014

Medicaid Doctors Set for a 42 Percent Payment Reduction

Congress is preparing to conclude the current term without action on extending relief from upcoming cuts in Medicare and Medicaid physician payments. There still is time for the next Congress to act on what is familiarly known on Capitol Hill as the “doc fix” before payments are reduced on April 1. However, a separate cut in Medicaid physician fees for primary care services is set to begin on January 1, 2015.

The Affordable Care Act included a temporary increase in federal Medicaid funding to increase payments to physicians to match Medicare payment levels. The temporary period expires at the end of the year. A report released on Wednesday by the Urban Institute estimates that the payment expiration will lead to a 42.8 percent reduction in fees for primary care services for eligible providers. However, the fee reduction varies because some states plan to continue higher physician payments by using separate state funds.




By Paul Jenks Posted at 9:31 a.m.

December 10, 2014

Audit Report Exposes Flaws in Medicaid Networks

Many primary care physicians accept Medicaid patients. However, finding them can be difficult. Federal auditors examined lists of physicians supposedly covering Medicaid patients and found that more than half of primary care doctors were no longer at the address listed or do not accept Medicaid patients. The HHS Inspector General also found that 35 percent of Medicaid managed plans offered inaccurate information on providers, but the report did not assess access for fee-for-service Medicaid patients. Additionally, the auditors found that the median wait-time for an appointment is two-weeks, with some as long as a month and 10 percent requiring a two-month or more wait.

CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reported (subscription) Tuesday that the audit findings raise questions about whether plan networks are broad enough to serve the influx of patients entering the Medicaid system. Also, network woes could also apply to non-Medicaid insurance coverage offered by the health care law’s marketplace plans.

The auditors recommended:

CMS work with States to (1) assess the number of providers offering appointments and improve the accuracy of plan information, (2) ensure that plans’ networks are adequate and meet the needs of their Medicaid managed care enrollees, and (3) ensure that plans are complying with existing State standards and assess whether additional standards are needed. CMS concurred with all three of our recommendations.


By Paul Jenks Posted at 10:50 a.m.

November 19, 2014

The Other Physician Payment Extension Deadline

A seemingly permanent fixture on the congressional agenda is ongoing action to thwart cuts to Medicare payments to physicians and other health care providers. Congress is always focused on the annual effort to halt substantial Medicare payment cuts to doctors. However, there is another looming deadline on enhanced Medicaid payments to primary care physicians.

The Affordable Care Act included a provision that allowed for increased Medicaid payments to primary care physicians at 100 percent parity with Medicare payment rates. The revised payment program began in 2013 but the enhanced payment term was limited to two years and is now set to expire. Unlike the Medicare physician payment deadline, which expires on March 31, 2015, the Medicaid parity payment adjustment expires on Dec. 31, 2014.

A prepared Senate bill (S 2694) offers a parity payment extension for two more years and adds payments to other physician groups. The White House’s initial request for a stopgap-spending bill in September also included a suggestion for an extension of Medicaid payments. Congress now is scrambling to craft the elements of a final year-end omnibus spending bill or another stopgap funding resolution. If the Medicaid payment parity adjustment expires, physician groups likely will to press for retroactive adjustments in next year’s spending bills.



By Paul Jenks Posted at 9:12 a.m.
Medicaid, Medicare

November 5, 2014

Governor Race Results Signal Limited Medicaid Expansion

Most of the focus on Tuesday’s general election was on which party would control the U.S. Senate next year. The Republicans gained a shift in control of the chamber. Meanwhile, separate state governors’ races included a focus on an expansion of the Medicaid program.

The 2010 Affordable Care Act includes incentives to states to expand the Medicaid program. However, twenty-three states have yet to expand Medicaid eligibility under the health care law. CQ HealthBeat’s Rebecca Adams reported (subscription) prior to the election that many Republican governors have balked at an expansion, though a few GOP state chiefs in Utah and Indiana have adopted elements of expanded Medicaid eligibility. Governors of both parties also must negotiate with state legislatures to allow for an enlarged state-managed Medicaid program.

Races on Tuesday that focused on the Medicaid expansion included reelection challenges t0 several GOP governors who have rejected a full Medicaid expansion.  Democratic challengers did not fare well against the established Republican incumbents. Here is a rundown of some selected state governor elections:

  • Florida: Governor Rick Scott defeated Democratic challenger Charlie Crist
  • Maine: Governor Paul R. LePage (who has vetoed Medicaid expansion proposals) defeated Democratic challenger Rep. Michael H. Michaud
  • Wisconsin: Governor Scott Walker (who has adopted a partial Medicaid expansion) defeated Democratic challenger Mary Burke
  • Georgia: Governor Nathan Deal defeated Democratic challenger Jason Carter



By Paul Jenks Posted at 7:18 a.m.

November 3, 2014

Week Ahead: Election Impact Conference; Medicaid Conference, Ebola Response & the Health Impact of Climate Change

The mid-term elections on Tuesday are the primary focus ahead of lawmakers’ return next week for a lame duck session. On Thursday, CQ Roll Call is holding a post-election impact conference. Scheduled speakers include notable political insiders and CQ Roll Call reporters and editors.

For those interested in a respite from post-election analysis, the National Association of Medicaid Directors this week hosts a conference on the Medicaid program. The conference begins on Tuesday with an address from Health and Human Services Secretary Sylvia Mathews Burwell. However, the election also impacts the Medicaid program. CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reported (subscription) last week that the election results for state governors’ races could stall or expedite plans for a further Medicaid expansion into states that have not taken advantage of federal funding enticements to expand eligibility for Medicaid program.

The American Association for the Advancement of Science on Tuesday holds a discussion on the work of individuals and governments in West Africa in containing the Ebola virus outbreak. Also on Tuesday, the Center for Global Development hosts a panel discussion on challenges relating to efforts to fight drug-resistant Tuberculosis. Separately, a Society for International Development panel will discuss efforts to engage women as a means to foster stronger health care systems and improved health outcomes.

Meanwhile, a two-day conference begins today at the National Academy of Sciences examines scientific models on the health risks of climate change.  The sessions will be webcast and follows the release this weekend of a new UN report on the dire-consequences of climate change.


October 23, 2014

State Medicaid Directors Respond to Critique of Varying State Standards

Last month, Healthopolis noted a Department of Health and Human Services Inspector General report that surveyed the wide diversity of state approaches to regulating Medicaid managed care programs.

The Inspector General’s analysis prompted the National Association of Medicaid Directors to craft a response to the report, suggesting that the lack of consistency in state supervision of Medicaid programs is not necessarily a failure but rather illustrates different approaches to managed care programs, which are colored by the unique circumstances of each state in managing very complicated factors influencing the Medicaid program.



By Paul Jenks Posted at 2:15 p.m.

Health Programs Factor in Upcoming House Committee Leadership Changes

The focus on upcoming November congressional elections understandably centers on possible election results and which party will control the Senate. However, the election of a new Congress, which convenes in January, also starts the process for reconfiguring the leadership of pivotal House committees. Roll Call’s Emma Dumain and Matt Fuller today examine possible GOP leadership changes in 11 different committees.

Health care program funding authority, particularly for the Medicare program, falls under the jurisdiction of the House Ways and Means Committee. The committee’s current chairman, Michigan Republican Rep. Dave Camp is retiring and Wisconsin Republican Rep. Paul D. Ryan has the inside track — but has some competition — to take over the gavel of the powerful tax committee.

Ryan has led a long-running campaign to overhaul the Medicare program as the chief of the House Budget Committee. His annual budget proposals (view the 2015 budget plan) have suggested ideas on overhauling the Medicare program allowing Medicare beneficiaries to choose between competing private coverage programs with the federal government offering premium support payments. In 2011, a liberal advocacy group attacked an earlier Ryan Medicare proposal with a video featuring a Ryan look-alike actor pushing an elderly woman in a wheelchair off a cliff.  At the helm of the Ways and Means Committee, Ryan would have the opportunity to craft a Medicare overhaul measure instead of offering budgetary suggestions.

If Ryan departs from the budget panel, the heir apparent is the committee’s current Vice Chairman, Rep. Tom Price, a conservative physician from Georgia. Price is a staunch opponent of the 2010 health care overhaul law and has authored his own proposal on overhauling health insurance coverage options. Price’s plan relies on offering tax breaks to give people the means to buy health insurance instead of the current health insurance exchange plan subsidies.

October 9, 2014

CBO: Annual Deficit is Lower But Health Program Spending Is Up

The federal government ended the 2014 fiscal year with an estimated $486 billion annual deficit, which is the lowest deficit level since 2008. The Congressional Budget Office monthly budget report pegs the lower deficit estimate largely on increased receipts from taxpayers.

However, overall federal spending — measured as outlays — increased and Medicaid and health insurance subsidy payments increased by 19 percent over 2013 levels. The CBO identifies the 2014 start of subsidized insurance plans and expanded state Medicaid coverage as a main reason for overall spending increase. Federal outlays on Medicaid and insurance premium subsidies increased in 2014 by $49 billion.

In September, the final month of the fiscal year, defense spending and reduced unemployment benefit outlays were down by $2 billion but spending for Medicaid increased 10 percent and Medicare increased 5 percent.





October 8, 2014

Enforcement Delayed on New Home Health Wage Rules

The Department of Labor will temporarily pause enforcement of new overtime and minimum wage rules for home health care workers. The rules, which are set to begin in January, include the elimination of overtime exemptions and the application of minimum wage requirements for workers who help elderly or frail people with activities such as dressing, eating meals and taking medication. An appeal from state Medicaid officials concerned about the cost of the new wage requirements has prompted a six-month suspension of enforcement of the rules.

The Labor Department will publish a policy update on the delay later this week. The final home health wage rules were published in 2013 and set a start date of Jan. 1, 2015. However, several states expressed concerns about budgetary impact on state Medicaid programs of applying higher wage rates to home health workers. The actual start date of the wage requirements will continue to be Jan. 1 but the department will not bring any enforcement action against employers for violating the wage rules through June 30, 2015.

Senate Democrats, acknowledging the concerns of Medicaid officials, applauded the decision. Republicans urged the administration to completely scrap the entire home health worker wage adjustment.





By Paul Jenks Posted at 3 p.m.

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